Medicare Part A covers hospital stays, skilled nursing, hospice, and some home health care

Medicare Part A is hospital insurance. It pays for inpatient hospital care — meaning you stay overnight — plus related services like skilled nursing facilities, hospice care, and some home health visits. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working. Most people get Part A automatically when they turn 65.

Part A covers the full cost of your hospital room, meals, nursing care, and most hospital services after you pay a one-time deductible per hospital stay. The deductible amount changes each year. If you stay longer than 60 days in the hospital, you start paying a daily coinsurance amount — a fixed dollar amount per day — for days 61 through 90. Beyond 90 days, costs rise sharply. Part A also covers up to 100 days in a skilled nursing facility if you were hospitalized first, though you pay coinsurance starting on day 21.

Medicare Part B covers doctor visits, outpatient care, tests, and medical equipment

Medicare Part B is medical insurance. It covers doctor office visits, outpatient hospital services, diagnostic tests like blood work and imaging, physical therapy, mental health counseling, and durable medical equipment such as wheelchairs and oxygen. Part B also covers preventive services like annual wellness visits and cancer screenings at no cost to you.

Part B requires a monthly premium, which most people pay through Social Security. You also pay a yearly deductible before Part B starts covering costs. After you meet the deductible, you typically pay 20 percent of the cost for most services, and Medicare pays 80 percent. For some services like office visits, you may pay a fixed copay instead. The exact amounts change each year.

Key Takeaways

  • Part A covers hospital stays, skilled nursing facilities, and hospice; Part B covers doctor visits, outpatient services, and preventive care.
  • Part A has no monthly premium for most people; Part B requires a monthly premium that usually comes out of your Social Security check.
  • Both parts have yearly deductibles and cost-sharing amounts that change annually, so your out-of-pocket costs depend on the services you use.
  • Part A and Part B together do not cover dental, vision, hearing aids, or long-term custodial care in a nursing home.
  • Original Medicare (Part A and Part B) requires you to pay your share of costs; Medicare Advantage plans (Part C) bundle these benefits differently with different cost structures.

What Part A and Part B do not cover

Original Medicare has significant gaps. Neither part covers dental work, eyeglasses, hearing aids, or routine foot care. Part A does not cover custodial care — help with bathing, dressing, or eating — in a nursing home or at home, even though many people need this as they age. Part B does not cover routine physical exams unrelated to a medical problem, and neither part covers most prescription drugs.

Both parts also exclude cosmetic surgery, most acupuncture, and experimental treatments not yet approved by the Food and Drug Administration. If you travel outside the United States, Original Medicare generally does not pay for care you receive abroad, with rare exceptions for emergencies in Canada or Mexico.

How deductibles and cost-sharing work in Part A and Part B

Part A deductible applies per hospital stay, not per year. If you are hospitalized, recover at home for 60 days, then are hospitalized again, you pay the deductible twice. The deductible covers your hospital room and most services for the first 60 days; after that, you pay daily coinsurance amounts that increase the longer you stay.

Part B deductible is annual — you pay it once per calendar year, then your 20 percent coinsurance kicks in. Some preventive services have no deductible and no coinsurance; Medicare covers them fully. Other services, like certain mental health visits, may have different cost-sharing rules. The best way to know your exact costs is to ask your doctor's office or the facility what they bill Medicare and what your share will be.

Original Medicare versus Medicare Advantage: how coverage differs

Original Medicare is the traditional program run by the federal government — Part A and Part B as described above. You can see any doctor or hospital that accepts Medicare, and you pay your share of costs as you use services.

Medicare Advantage (Part C) is an alternative offered by private insurance companies. These plans bundle Part A, Part B, and usually Part D (prescription drugs) into one plan. They often have lower or no monthly premiums, but they typically require you to use doctors and hospitals in their network, and they may have higher copays or coinsurance per visit. Some Medicare Advantage plans include dental or vision coverage that Original Medicare does not. The trade-off is less flexibility in choosing providers and potentially higher costs if you use out-of-network care.

Prescription drug coverage: Part D and how it fits with Part A and B

Part A and Part B do not cover prescription drugs you take at home. For that coverage, you need Part D, a separate prescription drug plan you can add to Original Medicare. Part D is optional but recommended; if you delay signing up and later want it, you may pay a penalty for each month you were without it.

Part D plans are offered by private insurance companies and vary widely in which drugs they cover and how much you pay. You choose a plan during the annual enrollment period (October 15 to December 7 each year). If you have a Medicare Advantage plan, prescription drug coverage is usually included, so you do not need a separate Part D plan.

Preventive services covered at no cost

Medicare Part B covers certain preventive services with no deductible and no coinsurance — you pay nothing. These include an annual wellness visit with your doctor, mammograms, colonoscopies, blood pressure checks, cholesterol screening, diabetes screening, and flu and pneumonia vaccines. Preventive services are designed to catch health problems early, when they are easier and less expensive to treat.

Not every screening or test is covered. For example, routine physical exams unrelated to a specific health concern are not covered, and neither are most hearing tests. Ask your doctor which preventive services are right for you and whether Medicare will cover them at no cost.

Frequently Asked Questions

Do I have to pay for Part A if I worked and paid Medicare taxes?

No. If you or your spouse paid Medicare taxes for at least 10 years while working, you do not pay a monthly premium for Part A. You still pay the deductible and coinsurance when you use hospital services, but the premium itself is free. If you did not work long enough, you may be able to buy Part A, though the premium can be high.

What happens if I go to a doctor who does not accept Medicare?

If you have Original Medicare (Part A and Part B), you can see any doctor who accepts Medicare. If a doctor does not accept Medicare, they can still treat you, but you may have to pay the full bill upfront and then request reimbursement from Medicare yourself — a slower and riskier process. Always check whether your doctor accepts Medicare before your visit.

Does Medicare Part B cover my prescription medications?

No. Part B does not cover prescription drugs you take at home. You need Part D, a separate prescription drug plan, for that coverage. If you have a Medicare Advantage plan, prescription drugs are usually included. If you use Original Medicare, you must sign up for Part D during the annual enrollment period or when you first become may be able to access for Medicare.

Can I use Part A and Part B outside the United States?

Original Medicare generally does not pay for care outside the United States. There are rare exceptions for emergencies in Canada or Mexico if you are traveling directly between two parts of the United States. If you travel internationally, consider supplemental travel insurance. Some Medicare Advantage plans offer limited coverage abroad, so check your plan documents.

What is the difference between coinsurance and a copay?

A copay is a fixed dollar amount you pay for a service — for example, $15 for an office visit. Coinsurance is a percentage of the cost — for example, 20 percent. Part B typically uses coinsurance (you pay 20 percent after the deductible), while some services use copays. Your plan documents will tell you which applies to each service.